HRT, Menopause and Joint Pain: Revitalize 360 Approach

Joint pain during perimenopause and menopause can feel confusing, inconsistent, and honestly a little maddening. One day your body feels fine, and the next day your hips, back, knees, or shoulders feel like they’ve aged overnight. In this interview, Dr. Kevin O’Donnell of Revitalize Regenerative Orthopedics talks about the connection between hormones and musculoskeletal pain, why so many women are blindsided by these symptoms, and how HRT may become part of a more complete treatment conversation. Revitalize also now shares a home with Revitalize HRT & Wellness with Dr. Meghan O’Donnell, making it easier to look at both the orthopedic and hormonal sides of the picture in one place. She shares some of her insights as well in the article. Revitalize’s initial assessment includes a 90-minute visit focused on history, exam, education, and treatment planning.

When you evaluate joint pain in women going through perimenopause and menopause, how do you distinguish hormonal causes from structural or mechanical orthopedic issues?

So there’s kind of a newer term in the medical literature. It’s not really widespread yet, but it’s called musculoskeletal menopause syndrome. What happens is, as women go into menopause, they lose their natural estrogen production. Estrogen is a very important hormone for regulating things like inflammation, cartilage, and tendon and ligament healing and vitality.

As that goes down, women become more prone to musculoskeletal issues because of it. Probably 70 to 75% of perimenopausal or postmenopausal women are going to have some degree of joint, tendon, or ligament issues, and probably about 25% of postmenopausal women will have something that’s going to need treatment.

It’s a very important regulatory hormone for all those things. My main patient base is 45- to 65-year-old women, and I don’t think that’s a coincidence. I was great until age 50. I never had an issue till age 50. So it’s a real thing.

Optimizing hormones, lifestyle, supplements, and all those things matters. People generally think, “I’m just getting older. It’s wear and tear.” But the hormonal piece of this is huge.

What are some of the most common joint pain areas you see in women dealing with perimenopause or menopause?

It’s really the most common things people deal with anyway. Hips, knees, shoulders. I don’t know that there’s some giant distinction in the exact body parts compared to people who have these issues for other reasons, but it does seem to correlate more with the larger joints and the tendons and ligaments around them.

Frozen shoulder is a really good example. The majority of people I see with frozen shoulder are perimenopausal or postmenopausal women. But in general, I’d say the major joints of the body are where this tends to show up. People are just more prone to these problems during that stage of life.

How common is frozen shoulder with your patients?

Frozen shoulder is a biggie. The typical frozen shoulder patient can have symptoms anywhere from a few months to a few years. What frozen shoulder is, is something called adhesive capsulitis. There’s an inflammatory response of the lining of the joint, and it becomes adhered, so the ball and socket don’t move as well.

And I’d say about 80% of the patients I see with frozen shoulder are women between 45 and 65. So there is definitely a correlation there. If I see someone with new-onset frozen shoulder who is 49 and perimenopausal, yeah, I’m going to think about optimizing hormones as part of the bigger picture. Revitalize specifically highlights frozen shoulder treatment as one of its core services.

How do you treat frozen shoulder at Revitalize?

I have a great treatment for frozen shoulder. Traditional treatment is usually: give it time and it’ll go away. And it typically does, but it can take a long time, and most people who can’t move their shoulder are not really willing to wait that long.

Physical therapy is often recommended, and that can be helpful too. I don’t know that it really shortens the timeline, but it can help people function better while they’re waiting it out. Surgical options include a capsular release, where they go in and cut the capsule to give the joint more room, or manipulation under anesthesia, where they put you to sleep and kind of crank through it.

What I do is called hydrodilation. I go into the shoulder joint and basically inflate it with fluid to stretch that capsule out. We put a little steroid in there as an anti-inflammatory, I numb them up, do a nerve block, and then gently manipulate the shoulder. I’d say 80 to 90% of people, when they walk out that day, are at least 50% better, and often closer to 80% better. Then we tie that in with physical therapy.

This is not a biologic treatment. In fact, PRP can make frozen shoulder worse. But hydrodilation followed by manipulation works really well. Revitalize’s frozen shoulder page also describes hydrodilation as a minimally invasive option used in the practice.

How often do women come in with joint pain and never even realize hormones might be part of the issue?

A lot. You just don’t always know at first. You have to take into account how old they are, when they reach menopause, and start figuring it out as you go. It’s just much more common in that age group.

Historically, I haven’t really had the menopause stage built into my questionnaire because I’m treating the joints and trying to get them better. But now, with Meghan coming on and with more awareness around menopausal symptoms, it’s something I’m probably going to hone in on more.

Dr. Meghan O’Donnell adds, “I’m glad we’re talking about this now at Revitalize. Joint pain can be one of the more underrecognized presenting symptoms of peri menopause menopause and hormone imbalance. Estrogen and progesterone are both key for production/maintenance of collagen and anti-inflammation as well as estrogen has a role in joint lubrication. Testosterone as well helps play roles in recovery from exercise muscle mass and joint stability as well as anti-inflammation- to name a few of the ways that the sex hormones are an integral playing part of the musculoskeletal system. It would be remiss not to consider their role in a patient presenting with joint concerns, aches and pains, particularly in the perimenopausal menopausal population.”

And honestly, that’s an opportunity. If a woman comes in at 48, 49, 52, saying, “All of a sudden I feel like I have arthritis everywhere,” it would be a mistake not to at least think about hormones as part of what’s going on.

Why do so many women feel blindsided by menopause-related joint pain?

Because for a long time, nobody was talking about it. Women were taught their whole lives that menopause was this one magic moment and then suddenly you had hot flashes, and that was kind of the story. Nobody explained that it can be a roller coaster, that symptoms can come in waves, and that joint pain can absolutely be part of it.

A lot of women feel like they’re losing their minds because one day they can barely move and the next day they’re fine. So they start trying to figure out, “What did I do? Why does my back hurt like this? Why does my hip hurt like this?” Sometimes the biggest value is simply naming it and saying, “You’re not crazy. There may be another factor here.”

I think that reassurance matters a lot. It takes some of the mystery out of it.

Where does HRT fit into this conversation?

When I was in med school and residency, putting women on hormones was considered dangerous. That was the mindset back then after the Women’s Health Initiative era. It was basically, “This is part of life and we’re not doing anything.”

That’s changed. Today, Revitalize Regenerative Orthopedics is also home to Revitalize HRT & Wellness, which offers telehealth programs for hormone replacement therapy, metabolic balancing, and weight loss under Dr. Meghan O’Donnell, MD. So when an orthopedic patient’s symptoms suggest there may be a hormonal piece, the practice now has a built-in way to look at that side of the equation too.

Does that mean HRT is the answer for every woman with menopause-related joint pain?

No, not necessarily. Even in the interview, the point wasn’t that every woman needs HRT. The point was that women deserve for hormones to at least be part of the conversation.

Even if someone doesn’t want to go on HRT, or isn’t a candidate, it still helps to know there may be a reason for what they’re feeling. It helps to understand that the body isn’t just randomly falling apart and that there may be a hormonal driver contributing to inflammation, tendon issues, ligament issues, or joint pain.

That’s where the opportunity is: looking at the full picture instead of acting like every symptom is isolated.

“In cases like these, Kevin and I can partner in a patient care approach with evaluation for hormone imbalance and personalized targeted treatments where appropriate coupled with targeted regenerative therapies and treatments for specific joint problems with the goal for better patient outcomes,” shares Meghan.

What makes this an important conversation in orthopedic care right now?

Because women have been blown off for way too long. A lot of women have been told it’s just aging, or stress, or that it’s not that serious, when they’re dealing with real pain and real function loss.

From an orthopedic standpoint, if you’re doing everything you’re supposed to do and you’re still not getting better, it makes sense to ask whether there’s another mitigating factor. That doesn’t replace orthopedic care. It strengthens it.

That’s why this matters. It opens up another path for understanding why someone hurts and why healing may not be going the way it should. And that’s a huge opportunity for better care.

If you’re dealing with joint pain, frozen shoulder, or nagging orthopedic symptoms during perimenopause or menopause, Revitalize Regenerative Orthopedics takes the time to look deeper. Your 90-minute assessment includes a detailed history, physical exam, and education so you can better understand what’s driving your pain and what your treatment options may be. To schedule, visit Revitalize Regenerative Orthopedics, explore their frozen shoulder treatment page, or call 720-598-9498. For the hormone side of the conversation, the practice also directs patients to Revitalize HRT & Wellness through the orthopedic site.